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MSK > Hand Pathology > Flashcards

Hand Pathology Flashcards

1
Q

What two structures form the carpal tunnel?

A

Carpal bones

Flexor retinaculum

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2
Q

What passes through the carpal tunnel?

A

Median nerve

Nine flexor tendons - 4FDP, 4FDS, 1FPL

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3
Q

What does the median nerve innervate?

A

Lumbricals 1 and 2
Opponens pollici
Abductor pollicis brevis
Flexor pollicis brevis

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4
Q

Name the causes of carpal tunnel syndrome

A 
Pregnancy 
Rheumatoid arthritis 
Diabetes 
Chronic renal failure 
Hypothyroidism 
Idiopathic 
Wrist fracture
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5
Q

How will carpal tunnel syndrome present?

A

Parathesiae - thumb and radial 2 fingers
Worse at night
Loss of sensation
Weakness and clumsiness

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6
Q

Describe the examination in suspected carpal tunnel

A

Tinel’s test positive - percuss over nerve
Phalen’s test - hyper-flex wrists (prayer)
Thenar atrophy

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7
Q

What is the treatment for carpal tunnel?

A

Wrist splints
Steroid injection
Decompression under local anaesthetic

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8
Q

What happens in Dupuytren’s Contractures?

A

Specialised palmar fascia undergoes hyperplasia forming nodes and contractors at MCP and PIP joints

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9
Q

Describe the pathology of dupuytren’s

A

Proliferation of myofibroblast cells and abnormal collagen production (3 instead of 1), skin may be adherent to the fascia and puckered with palpable nodes present

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10
Q

What fingers care commonly affected by dupuytren’s?

A

Little finger and ring finger

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11
Q

What diseases can cause Dupuytren’s?

A 
Familial 
Alcoholic cirrhosis 
Diabetes
Thyroid 
Epilepsy medication
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12
Q

Name two disease associated with Dupuytren’s

A

Peyronies - penis

Leddrhose - feet

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13
Q

Name three types of surgery that can be done on dupuytren’s

A
  • fasciectomy (removal of tissue)
  • fasciotomy (division of cords)
  • amputation
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14
Q

What is a ganglion cyst?

A

Mucinous filled cyst found adjacent to a tendon/synovial joint

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15
Q

What are the names for ganglionic cyst depending on location?

A

DIP - mucous cyst
Wrist - dorsal/volar
Knee - bakers cyst

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16
Q

Describe the presentation of a ganglion cyst

A

Localised irritation/pain, firm smooth rubbery and should transluminate

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17
Q

What deformity will radial nerve palsy cause?

A

Wrist drop - extensor muscles don’t contract

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18
Q

What will median nerve lesion cause?

A

Distal - Ape hand

Proximal - hand of benediction

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19
Q

What nerve damage will cause abnormal `OK’ sign?

A

Anterior interosseous

20
Q

How will ulnar nerve damage present?

A

Ulnar claw - paralysis of 3rd and 4th lumbrical

21
Q

Describe ulnar paradox

A

Ulnar nerve damage can denervate flexor digitorum profundis - weakens the flexion of IP joints in 4th and 5th joint

22
Q

How does trigger finger arise?

A

Tendonitis of flexor tendon to a digit can result in nodular (scarring and fibrosis) enlargement.

23
Q

Where does trigger finger usually occur?

A

Distal to fascial pulley over MC neck - the nodule catches on and may get stuck - A1 pulley
Middle and ring finger

24
Q

How is trigger finger treated?

A

Steroid injection around the tendon

Surgery - incision of the pulley to allow the tendon to move freely - only A1 pulley

25
Q

Name the condition which involves swelling of the sheet of the 1st dorsal compartment tendons

A

DeQuervain’s Tenosynovitis

26
Q

Which tendons are affected by DeQuervain’s Tenosynovitis?

A

Abductor pollicis longus

Extensor pollicis brevis

27
Q

How does DeQuervain’s Tenosynovitis present?

A

Spontaneous red/swollen area proximal to the thumb

28
Q

Name two tests for DeQuervain’s Tenosynovitis

A

Finkelstein

Eichhoff’s

29
Q

How is DeQuervain’s Tenosynovitis treated?

A

NSAIDs, splint, rest, steroids, decompression

30
Q

What investigation should be done in DeQuervain’s Tenosynovitis?

A

Xray

31
Q

What is paronychia?

A

Infection within the nail fold - children or people who bite their nails

32
Q

How is paronychia managed?

A

Elevate, antibiotics, incise and drain

33
Q

What is a surgical emergency in the hand?

A

Flexor Tendon Sheath Infection

34
Q

Describe flexor tendon sheath infection

A

Infection of sheath tracking up palm and arm - limited extension due to pain

35
Q

What are Kanavel’s cardinal signs?

A

Affected finger held in fixed flexion
Fusiform swelling over finger
Painful to percuss over sheath
Painful on passive extension

36
Q

Describe the 5 types of fingertip injury

A 
1 - soft tissue 
2 - soft tissue and nail 
3- soft tissue, nail and bone 
4 - proximal 1/3 phalanx 
5 - proximal to DIP
37
Q

How are the 5 types treated?

A

1 and 2 - dressing
3 - repair bed and stabilise
4 - ablation
5 - V-Y flap

38
Q

How can subungal haematoma be treated?

A

Pressure causes pain - burning a paper clip with a bunsen to relieve pressure and pain

39
Q

What are the two types of surgery for hand fractures?

A

Closed reduction using K wires

Open reduction using plates

40
Q

What is skiers/gatekeepers thumb?

A

Ulnar collateral ligament injury due to a fall on an outstretched hand

41
Q

How is skiers thumb treated?

A

Splint

Surgical repair of ligament

42
Q

Describe boxer’s fracture and the treatment

A

Minimal displacement, no rotation

Buddy strap and early mobilisation of 5th MC near knuckle

43
Q

What is Mallet finger?

A

Soft tissue injury or avulsion fracture results in injury to the tendon - straightens the end of the finger
Tender/bruising resisted extension

44
Q

What is the treatment for mallet finger?

A

Splint 24/7 for 6 weeks

Surgery in chronic cases

45
Q

What is Bennett’s Fracture?

A

Fracture at base of first metacarpal bone with subluxation or dislocation
- pain swelling weakness in pinch grasp

46
Q

How is Bennett’s fracture managed?

A

Cast and rest

Closed reduction

47
Q

What is eschar?

A

Thick, leathery inelastic skin which can form after burns - requires surgical release to allow movement

MSK (22 decks)

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